Pathology Education

The second year of medical school certainly has a lot of information compared to first year. Fortunately, it is focused on the pathological abnormalities, which make learning the material much more fascinating. [Image provided by the National Cancer Institute]

Pathology

This field of study often associated with autopsies and coroner's investigates both the abnormal macroscopic and microscopic findings in anatomical tissues. Learning a subject that takes years to master is quite a challenge for the novice pathologist.

It has been difficult to narrow my study of the subject as there are so many sources to pull from. The professor has his way of disseminating the information and pathology review books are quite different from that style. I have learned that with more exposure to the subject, the better it falls into place. As with anything, repetition is bound to make a connection sooner or later. Since there is a grade at the end of all this, in this case I am hoping for sooner.

We started the year with cellular pathologies and more specifically when cells get out of control. One of the leading concerns today is cancerous growth whether on the skin, in an organ or rampant throughout the body. Although I certainly do not have a cure for it, I am just starting to appreciate what causes cancer and how it is manifested. Often times it is the result of a genetic deviation from normal that no longer suppresses rapid cell growth. However, there are environmental factors that contribute to the development of cancer too.

Examples of carcinogens include UV light, occupational chemicals, and even hormones. We are exposed to them in various amounts depending on our habits, environments and genetic vulnerabilities. There is little that can replace healthy eating, regular exercise, and minimal carcinogenic exposure. So until next time, don't get too much sun and stay away from those asbestos infested workplaces; it could mean the difference between life and death.

Clinical Corner

Asbestos Exposure

Despite workplace safety measures, exposure to asbestos has been linked to mesothelioma, a malignant cancer affecting the lining of the lungs and/or abdomen. Where pleural mesothelioma can cause difficulty breathing due to fluid in the lungs, peritoneal mesothelioma affects the intestines causing weight loss, pain, and fluid accumulation in the abdomen. The latter is also associated with bowel obstructions, anemia, and fever.

It is most commonly seen in individuals who work closely with asbestos or their families, but may not be symptomatic for years. Mesothelioma is diagnosed by a pathologist who obtains a biopsy for histological examination. It is treated by surgical removal of the organ involved, radiation or chemotherapy. It is difficult to treat and therefore has a poor prognosis. For this reason there are clinical trials being performed in an effort to find better outcomes.

Neck Pain Treatment

One highlight for osteopathic medical students is obtaining hands-on training in Osteopathic Manipulative Medicine (OMM). Cervical spinal manipulations are among the most anticipated of techniques and thankfully have successful outcomes.

Neck Therapy

With the Hollywood stigma and the spine tingling sound of cracking, it is no wonder that we have had to wait this long to learn the mechanics associated with such treatments. As students we are just as nervous performing the technique as we are to be the patient on the table. The risk of severe damage is reported to be rather low, nevertheless, attention to properly performing these treatments is critical.

There are numerous resources available for learning the art of OMM and the American College of Osteopathic Family Physicians' website outlines a few of the more common treatments performed by osteopathic doctors. Although it is needless to say, there is more available than we students have time to consume. After learning it in the lab, we have to take it upon ourselves to make the time to practice our new skills.

In cases of somatic dysfunction, when a diagnosis is obtained, a trained DO can perform these treatments which relieve unnecessary pain and muscle imbalance. Because it is so sensitive, the neck can have a significant amount of dysfunction. Osteopathic cervical treatment is a quick way for the patient to find relief from their symptoms, and it is an enjoyably unique part of most osteopathic medical students' curriculum.

EKG Training

While working in the Emergency Department, I saw a lot of electrocardiograms (aka ECG or EKG) but did not have the training to read them correctly. Now in our second year of medical training, we are learning the basics of a somewhat complicated art.

Electrocardiogram

An electrocardiogram is a medical tool that provides an electrical reading of the heart's activity. Once you get past placing the leads in all the right places, it is a matter of understanding what the data is trying to say. With lines, spikes, bumps, depressions and what seemingly looks like cat-scratch, they can appear quite daunting to the amateur like myself. Careful observation and study of the markings can reveal a lot of pertinent information about the patient's anatomy and cardiac condition.

EKG training has branched out from the classroom to include online resources and texts that provide a quick reference to normalcy and abnormalities. As both an educational tool and reference book, Dale Dubin has published an easy to read book, Rapid Interpretation of EKG's, which I would recommend to any student of the art. Once there is a foundation of the principles, it is useful to consider a number of unique readings to see how they actually look. Dr. Wes, an electrophysiologist and cardiologist, occasionally shares EKG's on his blog for reader interpretation before posting his diagnosis. In this way, readers are exposed to various rhythms that demonstrate critical findings.

Being competent enough to know what you are seeing is a significant task when reading an EKG. With time and practice, I could be well on my way to understanding it a little better than before. Pathological indications will be jumping off the screen giving vital hints as to what treatments are required, and it's my job to recognize them when I see them. Fortunately, they will not be on living patients for another year.

Bicycle Transportation

We've only had three days of class and I already feel behind in my work. Between previewing lecture notes, reviewing lecture notes and reading the texts, I seriously wonder if I will have enough time to do anything else. At least getting to and from school will now be beneficial in relieving some of that stress. Check out my new wheels!

Scheduling Overload

Somewhere between the end of first year and the start of second year I lost a lot of important information mentally. As we cover certain subjects again, I can feel that sense of lost recognition. The professors certainly did not wait to open the flood gates and started in full force. After pharmacology and pathology were introduced, I felt my time would be well occupied. But it didn't stop there, they tacked on behavioral medicine, medical microbiology/immunology, clinical systems, osteopathic manipulative medicine (OMM), and objective structured clinical exams (OSCE).

On top of all that, I plan to squeeze in time for work-study in the anatomy lab, tutoring, several interest groups of which I'm an officer for two, and act as a "big sib" to a couple of the first year students. I smell burnout in the near future.

Stress and Anxiety Relief

In an effort to reduce some stress and use my time efficiently, I purchased a great bike at a great price thanks to Craig's List. Last year, I was in the worst shape of my life due to classroom inactivity. I'm hoping this year will be different. Amid the busy schedule, I don't see a whole lot of time for exercise and plan to ride my new bike to school instead of taking the car. Surprisingly, it takes almost the same amount of time to travel due to an abundance of traffic lights. At least this way I will be getting some movement into my otherwise sweat-less chair routine and burning useless calories in the process.

Sports Physcial

Not only is school starting in a matter of days for Touro University students, but high school students too are getting ready for the coming year. In conjunction with a local sports medicine clinic a few of my classmates and I teamed up to provide pre-participation exams for students trying out for various high school sports.

First Patient

Although our cadavers may have been our "first patients" as medical students, they were not breathing. So my first patient would have to be among the students I examined this last week. Each of the medical students were assigned an exam room where we obtained vital signs, medical histories, and performed sports physical exams.

After talking with some of my colleagues, I don't know who was more nervous, the medical students or the highschoolers. During first year, we were never instructed how to perform genitourinary exams. Given this responsibility among other tasks, we were expected to be professional and lead the exams in a timely manner. Looking back on it, it really wasn't so difficult. I assume at this point in my education, there are going to be a lot of firsts. Fortunately, this one was a positive experience.

I can tell there is a lot to be learned as the flow seemed a little choppy. In all, it was great exposure to the physical exam, younger patients, and my weaknesses as a learning student. It gives me something to work towards the next time around.